Transcript Single Motherhood and Child Mortality in Sub

Single Motherhood and Child Mortality
in Sub-Saharan Africa:
A Life Course Perspective
Shelley Clark
Associate Professor of Sociology
Canada Research Chair in Youth, Gender and Global Health
McGill University
Dana Hamplová
Assistant Professor & Research Associate
Charles University & Institute of Sociology, ASC
Social Statistics Speakers’ Series
McGill University
November 9, 2011
Consequences of
Single Motherhood
in North America & Europe
1) Greater poverty among single mothers (Bianchi,
Subaiya and Kahn 1999; Holden and Smock 1991)
2) Poorer child outcomes (Amato 2000; Seltzer 1994)
–
–
–
cognitive development (Gennetian 2005)
behavioral adjustment (Magnuson and Berger 2009)
health outcomes (Angel and Worobey 1988; Dawson 1991)
Consequences of
Single Motherhood
in Sub-Saharan Africa
1) Greater poverty among
single mothers???
2) Poorer child
outcomes???
Consequences of
Female-Headed Households
on Poverty
– Belief that rising rates of female-headed households
(FHHH) are evidence of the “feminization of poverty”
– Quisumbing and colleagues (2001) provide a careful
study of the link between FHHH and poverty in 10
countries and discover that this link is rather weak and
not consistent
– In studies of individual countries, sometimes FHHH
are poorer and sometimes they are richer!
Consequences of
Female-Headed Households
on Children’s Health
– South Africa: no relationship between the sex of
household head and childhood mortality (Hargreaves
et al. 2004)
– Kenya: Children in FHHH are more likely to be
stunted, but less likely to suffer from wasting
(Onyango, Tucker and Eisemon 1994).
– Several other studies describe a positive association
between female-headed households and child health,
as measured by food security and child nutrition
Problem with Measures of
Female-Headed Households
• Why are some female-headed households richer?
–
–
–
–
Includes women married to migrant men
Over-represents economic “survivors”
Excludes “sub-families” or “disguised” FHHH
Ignores long-term effects for remarried women and their
children
• Why are some children in FHHH healthier?
– All of the above
– Women tend to invest a higher proportion of household
resources towards children
We need a better measure!
Single Motherhood Over the Life Course
Our Research Questions
1) How common is it for women to experience
an episode of single motherhood over their
life course?
2) What are the effects of single motherhood on
child mortality rates?
Data and Analytic Approach
• Demographic and Health Surveys (DHS)
– Ethiopia (2005)
– Kenya (2003)
– Tanzania (2004-2005)
– Malawi (2004)
– Zimbabwe (2005-2006)
• Life course approach by using five-year
retrospective marital history calendars
Marital History Calendar
DHS Malawi 2004
……
Analytic Samples
Ethiopia
Kenya
Malawi
Tanzania Zimbabwe
Q1: All women
14,070
8,195
11,698
10,329
8,907
Q2: All children born
in calendar
11,210
6,409
12,268
10,040
6,073
Question #1
How common is it for women to experience an
episode of single motherhood over their life
course?
Pathways into Single Motherhood
Pre-marital SM
Post-marital SM
• Gave birth before date of first
marriage
• Divorced or widowed with at least
one child under the age of 15
Data for Q1
• Marital Histories
– Full dates of all union formations and dissolutions
during the calendar
– Date of first union
– Number of unions
– Martial status at time of survey
• Birth Histories
– Full birth dates of all children ever born
– Full death dates if the child has died
Measure of Single Motherhood
• Examples of Premarital SM:
Marital History Calendar
Marital History Calendar
• Examples of Postmarital SM:
Marital History Calendar
Marital History Calendar
?
?
Marital History Calendar
Models for Q1
• Premarital SM: Competing risks models of having a
first birth before first marriage (1=premarital birth,
2=marriage, 3=censored (Coviello and Boggess 2004)
• Post-marital SM: Kaplan-Meier cumulative risk of
becoming a single mother after first marriage by age.
Left truncation for 13% of women in Zimbabwe and
19% in Ethiopia.
• Total SM: Kaplan-Meier cumulative failure curves for
entry into single motherhood either before or after first
marriage.
Cumulative Risk of Single Motherhood
Zimbabwe
Kenya
Malawi
Ethiopia
0
.1 .2 .3 .4 .5 .6 .7 .8 .9
1
Ethiopia
10
15
20
25
30
35
40
age
premarital single motherhood
total single motherhood
postmarital single motherhood
45
0
.1 .2 .3 .4 .5 .6 .7 .8 .9
1
Kenya
10
15
20
25
30
35
40
age
premarital single motherhood
total single motherhood
postmarital single motherhood
45
0
.1 .2 .3 .4 .5 .6 .7 .8 .9
1
Malawi
10
15
20
25
30
35
40
age
premarital single motherhood
total single motherhood
postmarital single motherhood
45
0
.1 .2 .3 .4 .5 .6 .7 .8 .9
1
Tanzania
10
15
20
25
30
35
40
age
premarital single motherhood
total single motherhood
postmarital single motherhood
45
0
.1 .2 .3 .4 .5 .6 .7 .8 .9
1
Zimbabwe
10
15
20
25
30
35
40
age
premarital single motherhood
total single motherhood
postmarital single motherhood
45
Nairobi, Kenya (HDSS)
Single Motherhood over the Life Course
vs.
Current Measures of Female Headed Households
– 30% to 70% lifetime risk of single motherhood
– 9% to 16% currently single mothers
– 13% to 20% current FHHH
Question #2
What are the effects of single motherhood on
child mortality rates?
Models for Q2
Random-effects discrete-time logit model
Where
htij
= hazard that child i of mother j dies at time t
Marstat=Marital status of mother (time-varying)
Mother=Mother’s characteristics
Child=Child’s characteristics
=Child’s age (time function)
u=Mother-level random effect
Key Variables
Ethiopia
Kenya
Malawi
Tanzania
Zimbabwe
7.9%
8.1%
9.0%
8.1%
6.4%
Never SMb
93.0%
83.0%
84.5%
84.1%
82.1%
Ever SM
7.0%
17.0%
15.5%
15.9%
18.0%
Child died < 5
Marital Statusa
a: In the last month of observation.
b: Includes women married at the time of the child's birth or within six
months of that date.
Mother’s Characteristics
•
•
•
•
•
Education (4% Z to 77% E; no education)
Religion
Urban residence (11% M to 26% K & Z)
Household wealth (quintiles)
Region
Child’s Characteristics
• Sex
• Mother’s age at birth (16% E to 21% M; < 20)
•
•
•
•
Birth order
Previous birth interval (< 2 years)
Previous sibling’s death
Child’s age () (mean 2.5 years)
–
–
–
–
–
First month
First year (months 1-11)
One to two years
Two to three years
Three to five years
1.00
The Effects of Ever Being a Single Mother on Child Mortality
0.90
***
0.80
***
Odds Ratio - 1
0.70
**
0.60
***
0.50
**
0.40
0.30
0.20
0.10
0.00
Ethiopia
Kenya
Malawi
Tanzania
Zimbabwe
1.10
The Effects of Single Motherhood and Education on Child Mortality
* **
Ever SM
No Educ/Secondary
0.90
***
***
Odds Ratio - 1
0.70
**
*
***
0.50
**
*
0.30
0.10
Ethiopia
-0.10
Kenya
Malawi
Tanzania
Zimbabwe
Types of Single Motherhood
Ethiopia
Kenya
Malawi
Tanzania
Zimbabwe
Never SMb
93.0%
83.0%
84.5%
84.1%
82.1%
Ever SM
7.0%
17.0%
15.5%
15.9%
18.0%
Marital Statusa
Premarital SM
0.8%
8.8%
3.6%
6.4%
6.0%
Postmarital SM
6.1%
8.2%
11.9%
9.5%
12.0%
Divorcedc
Widowhoodc
(3.8%)
(5.1%)
(7.0%)
(5.8%)
(6.6%)
(1.7%)
(2.5%)
(2.1%)
(1.8%)
(4.1%)
a: In the last month of observation.
b: Includes women married at the time of the child's birth or within six months of that date.
c: Excludes children whose mothers remarry by the time of the survey
1.2
Effects of Premarital and Postmarital SM on Child Mortality
***
1
Never SM (ref)
***
Premarital SM
Postmarital SM
***
Odds Ratio - 1
0.8
*** ***
***
0.6
0.4
*
0.2
0
Ethiopia
Kenya
Malawi
Tanzania
Zimbabwe
Effects of Divorce and Widowhood on Child Mortality
1.4
Never SM (ref)
***
Premarital SM
1.2
***
Divorced
Widowed
***
1
***
**
***
Odds Ratio - 1
0.8
**
0.6
*
0.4
0.2
0
Ethiopia
-0.2
-0.4
Kenya
Malawi
Tanzania
Zimbabwe
(Re)marriage among Single Mothers
Ethiopia
Kenya
Malawi
Tanzania
Zimbabwe
93.0%
0.6%
5.6%
0.8%
83.0%
6.2%
7.6%
3.2%
84.5%
1.9%
9.6%
4.1%
84.1%
3.9%
8.0%
4.0%
82.1%
4.3%
11.0%
2.7%
Marital Statusa
Never SMb
Premarital SM
Postmarital SM
(Re)married
a: In the last month of observation.
b: Includes women married at the time of the child's birth or within six
months of that date.
6
Effects of Types of Single Motherhood on Child Mortality
***
Never SM (ref)
5
Premarital SM
Postmarital SM
(Re)married M
Odds Ratio - 1
4
3
2
***
1
**
*
** ***
*
**
0
Ethiopia
Kenya
Malawi
Tanzania
Zimbabwe
Discussion and Conclusions
• If current trends continue between 30% and 70% of young women in these
countries can expect to become a single mother at some point before
reaching their 45th birthday.
• The pathways into single motherhood differ across countries.
• Having a single mother increases the odds of dying before the age of 5
between 43% and 83%.
• Children born to never married mothers are more likely to die in 3 of 5
countries, while children whose mothers are divorced or widowed have
significantly higher rates of mortality in 4 of 5 countries.
• Children of divorced women tend to fare worse than children of widows.
• (Re)marriages do not tend to significantly improve the survival chances of
children.
Data Limitations
What are the mechanisms linking single
motherhood to poverty and child mortality?
– To what extent does greater poverty account for the
relationship between single motherhood and child
mortality?
– Where do the children of premarital, postmarital, and
remarried single mothers live?
– What is it about these households that causes these
children to suffer higher rates of mortality?
Postmarital SM and Poverty
0.00
0.25
0.50
0.75
1.00
Malawi: postmar after 1st mar: all
10
15
20
25
30
age
v190 = poorest
v190 = middle
v190 = richest
35
40
v190 = poorer
v190 = richer
45
Postmarital SM and Poverty
0.00
0.25
0.50
0.75
1.00
Tanzania: postmar after 1st mar: all
10
15
20
25
30
age
v190 = poorest
v190 = middle
v190 = richest
35
40
v190 = poorer
v190 = richer
45
Future Research
• Need better retrospective and prospective data
1)
(H)DSS in Ouagadougou, Burkina Faso
•
•
•
2)
(H)DSS in Nairobi, Kenya
•
•
•
3)
Urban setting with a mix of Muslim and Christian population
80,000 individuals
Interviewed once a year
Straddles two slums in Nairobi, Korogocho and Viwandani
70,000 men, women, and children is extremely poor
Collects data twice a year
(H)DSS in Agincourt, South Africa
•
•
•
Rural site covers one of the former homelands
120,000 individuals in this site are refugees from Mozambique
Twice a year, follows moves and migrants
• Need qualitative interviews on women’s motherhood and marital histories